This document is a letter from the Department of Early Learning upholding the finding of a valid complaint against a child care program. The complaint regarded the program's refusal to assist a child with Type 1 diabetes with necessary medical care. The decision was made after reviewing documents provided by the family and program. It was determined that while the program was aware of the child's medical needs, they did not make reasonable accommodations or efforts to assist the child as required by federal disability law. The responsibility was improperly placed on the family to provide all care or pay for a separate aide.

1. Paula Smith
C/O Tracy M. Miller
701 5th Ave Suite 3300
Seattle, WA 98104
Provider ID#: 192295
Dear Ms. Smith:
STATE OF WAS.HlNGTON
DEPARTMENT OF EARLY LEARNlNG
805 156th Ave NE
Bellevue, WA 98007
Must be Certified Mail or Hand Delivered
April 21, 2014
The Department of Early Leaming received your request on March 10, 2014; DEL reviewed your
Regional Administrator review request of:
0 Compliance agreement dated regarding .
Valid complaint finding(s) from complaint# 439998 received on November 15, 2014.
D No referral status due to mistaken identity received on
During the review process the following materials were provided and taken under consideration:
Written statement from you explaining specific reasons/conditions for the review.
Relevant materials from your licensing file.
Other: RCW 43.215 and WAC 170-295
This review has been concluded and a decision has been made:
The licensor's decision has been upheld because:
The letter contesting the Valid complaint finding states that, "the dispute about accommodations
o has arisen because (I) the full extent of need for nursing care was not apparent
when he was first admitted to the School; and (2) the School does not employ a nurse and cannot,
therefore, provide "nursing care," which includes the non-delegable duties of administering
medication and piercing the skin."
Point (1) above states that the school was not aware ofthe full extent of the child's needs. The
documentation obtained shows that the family was proactive in notifying the school ofthe child's
needs starting with the admission paperwork, extending themselves to meet and further discuss
any questions staff may have and by offering to arrange for training even after the child began
attending the program.
· On 01/22/13, the family submitted an essay and enrollment paperwork for their two children.
The essay clearly disclosed that the child has type 1 diabetes and requires blood glucose level
checks and insulin. When asked to include any other information that the caregiver feels is
10.9. l.3 Supervisory Review Decision Letter
Rev. 2/13
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2. important for the school to know the parent wrote, "As mentioned elsewhere in this application,
has type I (juvenile) diabetes that is well controlled and places no limits on his abilities.
However, it is necessary for teachers to be aware ofhis condition and to know a few basic facts
about it." Furthermore, the parents articulated that with basic training the child's previous
teachers were able to quickly learn how to assist the child. The children were later accepted into
the full-day Early Elementary Program on 03/15/13.
Following the child's acceptance into the program, and prior to the beginning ofthe school year,
the family initiated mutliple attempts to correspond with the school asking how they could help
educate and prepare staffto assist their child with his diabetic needs. Included in the
correspondence was a PDF document titled, "Helping the Student with Diabetes Succeed: A
Guide for School Personnel." Ms. Angie Goodwill acknowledged receipt ofthis document on
07/26/13 and informed the family that the school would be touching base with them closer to the
start ofthe school year.
On 08/28/13, Ms. Melissa Chittenden emailed the family to reiterate the messages previously
discussed during a 08/27/13 meeting. Ms. Chittenden specifically stated, "...I'm optimistic that
we can work together with you to figure out a way for to get the medical care he needs
from someone other than a UCDS employee..."
In their continued efforts to help educate staff, the family arranged for pediatric endocinologist
Dr. Craig Taplin and diabetic educator Amanda Peters to provide a presentation on the basic
supervision and monitoring ofthe child's diabetic needs. During this presentation Ms. Chittenden
reportedly stressed to staffthat they did not have to assist the child with his diabetic are, but
rather the material presented was for informational purposes only.
On 09/23/13, the family completed and signed a Diabetes Medical Management Plan that
specified the child's needs.
Point (2) states that the school does not employ a nurse and cannot, therefore, provide "nursing
care," which includes the non-delegable duties ofadministering medication and piercing the
skin."
During a meeting held on 10/11/13, you informed the family that the school staffwould not
directly assist the child with his medical needs.
Federal laws state that child care programs must do an individualized assessment ofany child
with diabetes and reasonably accommodate their needs. To facilitate appropriate care, staffmust
have an understanding ofdiabetes and be trained in its management and emergencies. Based on
documentation obtained during the complaint inspection, there was no evidence that the school
made any efforts with their staffto assess the child's individual needs and make
accommodations to assist him directly.
The US Department ofJustice Commonly Asked Questions About Child Care Centers and ADA
clearly specifies that programs are generally required to test a child's blood sugar levels.
Additionally, it specifies that providers should follow directions for simple diabetes-related care
as outlined by the parents and physician. "In most instances they (parents) will authorize the
provider to monitor the child's blood sugar- or "blood glucose" - levels before lunch and
10.9.l.3 Supervisory Review Decision Letter
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3. whenever the child appears to be having certain easy-to-recognize symptoms ofa low blood sugar
incident. While the process may seem uncomfortable or even frightening to those unfamiliar with
it, monitoring a child's blood sugar is easy to do with minimal training and takes only a minute or
two. The parents are responsible for providing all appropriate testing equipment, training, and
special food necessary for the child."
Washington Administrative Code (WAC) 170-295-3050 specifically states, "Ifa child has a
condition where the Americans with Disabilities Act (ADA) would apply you must make
reasonable accommodation and give the medication." As mentioned, Federal laws have
considered diabetes to be a disability. The family articulated that the child is knowlegable about
his condition and has some self care skills, however they also articulated that he requires adult
supervision and/or assistance with his daily care.
Based on review ofthe information obtained during the course ofthe complaint inspection it is
concluded that although the school enrolled the child into the program with knowledge ofthe
child's condition, efforts were not made to make reasonable accommodations to directly help the
child. Rather, the program offerred a stipend up to $10,000.00 and placed the responsibility on
the family for being at the school and/or hiring a separate person to be at the school each day.
This does not meet the intent ofthe WAC and therefore I am upholding the licensor's decision to
conclude the complaint as Valid.
D The licensor's decision has been overturned because:
D Other:
IZI Ifyou are not satisfied with this review, you may request the next level ofreview by
contacting:
Mary Kay Quinlan
Statewide Licensing Administrator
PO Box40970
Olympia, WA 98504-0970
(360) 407-1972
D This is DEL's final review.
Your request must be received no later than 10 days after the receipt ofthis letter.
Ifyou have any questions, please feel free to call me at:(425) 590-3102
Sincerely,
....
Heather West
NW Regional Administrator
10.9.1.3 Supervisory Review Decision Letter
Rev. 2/13

4. Department ofEarly Learning
cc: Noy Sivongxay, Child Care Licensor
Deanna Sundby, DEL Licensing Analyst
Heather West, DEL Regional Administrator
10.9.1.3 Supervisory Review Decision Letter
Rev. 2/13

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